EmailMeForm
Credit Application Form
.
Every field on the application must be completed, failure to do so may result in your pllication being delayed.
Full Trading Name
*
Details of Previous Trading Names
Type of Business
*
Please select
Limited Company
Sole Trader
Partnership
Full Trading Address
*
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Invoice Address (if different from above)
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Registered Office Address
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Account Details
Accounts Contact Name
*
Prefix
First
Last
Contact Phone
*
Email Address for Invoices
*
Email Address for Statements
*
Company Registration Number
VAT Number
Approx Annual Turnover
*
£
Pounds
Anticipated Monthly Credit Level
*
£
Pounds
Do you Issue Purchase Order Numbers
*
Yes
No
Owner Declaration
Name(s) and address(es) of all owners/partners (if not a limited company)
Name 1
Prefix
First
Last
Name 2
Prefix
First
Last
Address 1
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Address 2
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Have you ever been a director of a company which has had a receiver / liquidator appointed
*
Yes
No
References
Please provide the name, address and contact details of two trade references.
Reference 1
*
Prefix
First
Last
Reference 2
*
Prefix
First
Last
Contact Phone
*
Contact Phone
*
Address 1
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Address 2
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
NEW ACCOUNTS WILL ONLY BE OPENED SUBJECT TO SATISFACTORY CREDIT REPORT AND TRADE REFERENCES
Payment is due 30 days from date of invoice unless otherwise agreed. (Please refer to section 7 of the terms and conditions)
DECLARATION
I have read a copy of Highfield Environmental Ltd terms and conditions of trading and fully agree to abide by them
Name
*
Prefix
First
Last
Date Time
*
DD
/
MM
/
YYYY
Position in Company
*
Declaration Confirmation
*
Yes
No
Ticking YES is your acceptance of Highfield Environmental Ltd Terms & Conditions
